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5/22/2012 @ 11:45AM14,454 views

Why The Media 'Can't Handle the Truth' About Accretive Health

Contributor’s Note: We at insideARM.com have been covering the Accretive Health (NYSE:AH) “scandal” since Minnesota Attorney General Lori Swanson first published her 100+ page report indicting (in the common, not legal sense of the word) Accretive for badgering patients into making payments and other debt collection abuses [sic]–or at least that’s what an overwhelming majority of mainstream media outlets heard when they rained down invective in headline after headline on the Illinois-based revenue cycle management company.

But in reality the scandalous aspect of the Accretive yarn doesn’t lie with the subject of those stories; it falls squarely upon reporters and Ms. Swanson herself for a failure of clear vision. In the words of Col. Nathan R. Jessup in A Few Good Men (1992): “You can’t handle the truth!” I would argue that at the precise moment in Rob Reiner’s film when Jack Nicholson’s Jessup utters those now-iconic words, he’s 100 percent correct. Jessup’s problem, however is that he also committed a crime under military law. But those things–the excited utterance and the crime itself are, for an instant, mutually exclusive. Tom Cruise and Demi Moore and all the fictional American civilians in the motion picture cannot, in fact, handle the truth–AND Col. Jessup’s actions led to the death of one of his men.

If one were to produce “A Few Bad Debt Collectors” to chronicle the saga that has unfolded around Accretive Health, the story line would be much the same… well, half of it. Journalists across the country and the most powerful lawyer in the State of Minnesota can’t handle the truth about Accretive. Too bad (regarding box office receipts for our made-up blockbuster) that Accretive, unlike Jack, didn’t commit any crime.

When the Minnesota Attorney General’s office issued a scathing report criticizing how a hospital contractor managed the collection of patient fees, it inadvertently attacked what are correctly understood as vital health care industry best practices for revenue cycle management (RCM).

Last month Minnesota Attorney General Lori Swanson released a six-volume “compliance review” of Minneapolis-based Fairview Health Services, a not-for-profit chain of seven hospitals and more than 40 clinics, and its contractual relationship with Accretive Health, a publicly traded firm offering revenue cycle management services for hospitals.

Swanson’s report directed most of its ire at Accretive, the out-of-state company, rather than the hospital/clinic system based in her state, even though many of the policies and procedures her office found repugnant were in place before Accretive took over management of Fairview’s revenue cycle operations. The national media jumped upon the more salacious parts of the compliance review report upon its release and Accretive’s stock fell by half in the day’s following the AG’s announcement.

Over the last 10 days, Accretive has fought back, launching a counter public relations effort, denying the charges, accusing the Attorney General of acting in bad faith and launching an initiative to establish national standards for patient financial practices.

The Attorney General must be feeling the heat. In the midst of Accretive’s PR campaign, the AG’s hometown paper, The Minneapolis Star Tribune (whose pro-consumer sympathies are well documented), last week published a story about Fairview complaints against Accretive that was nothing more than a regurgitation of the charges released in April. The Attorney General has now added a link to her main web page, actively soliciting the public for complaints about Accretive.

Attorney General Swanson has yet to file any civil or criminal complaints against Accretive related to the release of the report, although in January her office did file a lawsuit against Accretive for losing a laptop that contained patient information. Despite more than 113 pages of accusations and supporting material dealing with a company in one of the most regulated industries in the United States there has not been one new lawsuit or criminal charge.

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“People with medical debt—both uninsured and those with private insurance—are much less likely than those without debt to fill a prescription, see a specialist when needed, or visit a doctor or clinic for a medical problem, and they are more likely to skip a needed test, treatment, or follow-up.” http://content.healthaffairs.org/content/25/2/w89.full

This is the essence of the problem, and any discussion of industry “best practices” that doesn’t consider it (or would make it worse) only sidesteps the five-thousand pound elephant in the room. Healthcare is fundamentally different in this regard than any standard business–people’s health and, indeed, very lives are at stake.

I guess I have this quaint notion that people who would approach me throughout the duration in which I’m hospitalized will be those whose primary interest is in my health and well-being. Debt collectors don’t fit into that category. Furthermore, hospitals are already full of enough germs without bringing in money-changers to the patient’s bedside. Finger your coins and currency, swipe your credit cards, and lick your envelopes in another setting, please. Better yet, let’s adopt Canadian-style universal health care and do away with the billing office entirely.

We can talk about personal responsiblity and how those who avoid healthcare for themselves and their families are more at fault than the debt collectors who come after them. I think some would rather amputate their own arm with a rusty pocket knife than subject themselves to the perceived shame of being buttonholed in a situation in which there’s no possible escape.

That’s another somewhat hidden truth about debt collection. It’s not just about transferring monetary amounts between accounts–computers can do that. It gets a bit more personal than that. Indeed, an astute reader will see the shaming in this comment thread; and, indeed, mea culpa as well.

I recall some reading a story in college where an agressive traveling encylopedia salesman stops a farmer on his tractor in the field. When the farmer declines his sales pitch, the salesman unleashes on him: “You’re stupid, you’re wife’s stupid, do you want your kids to grow up to be stupid, too?!” Now, the implied rhetoric has shifted a bit: “You’re irresponsible, you’re wife’s irresponsible–do you want your kids to grow up to be irresponsible, too?!” Oh yeah, this shaming thing is kinda fun. I can see how it could add a little pizazz to a working life otherwise only filled by the numbers on a spreadsheet.

Thank you for sharing that source. I don’t deny that medical debt is one among many factors that contribute to patients’ decisions to defer seeking care. And I agree that those choices are unfortunate, unwise, and even potentially dangerous.

You raise the issue of personal responsibility in your most recent comment (and then quickly dismiss it to talk about shaming). But I also think you’re misreading the post or some of the things I’ve said by casting my remarks as if the patient has personal responsibility to Accretive. They don’t–but patients do to hospitals and clinics that provide services that cost money. That money has to come from somewhere–but that’s not really what we’re talking about here. And (as I think we made clear in this and other posts as well), we’re not talking about traditional third-party debt collection. We’re not talking about bad debt. Accretive staff weren’t “chasing past due bills” in this context. Part of the issue this post is trying to clarify is the inaccurate depiction of the Accretive-Fariveiw relationship as traditional debt collection.

What somehow got lost in your recent comment was my question about “facts” and “crime” that you asserted in your original remarks. The subject of this blog isn’t “medical debt collection as a business” or whether people in this country should have access to affordable health care (which, by the way, I personally think they should). The subject of this post was, in my view, a hatchet job performed on Accretive and Fairview in the media at the hands of a state attorney general with a big microphone–but absent any legal arguments or actions.

Your first comment, like the hundreds of articles written about Accretive’s “transgressions” asserted that a crime(s) had been committed. This post, and my comments here, simply critique those claims. So it seems to me we should be talking about “negligent homicide” rather than paper currency causing staph infections.

Thanks for the personal reply. I was actually replying in this thread to RevCyc and hadn’t seen your original reply yet as I composed my message offline. It was only coincidental that I had provided a source as you had asked for. I will reply to your post later (in the thread preceding this one) as I want to thoughtfully address the questions you raised. I think the issues transcend simply legal ones, and I used my terms similarly to how you used the word “indicting.”

The American Health Care system needs an overhaul. The “Affordable Health Care Act” is a bad joke.

What the United States needs is a single payer system like we have in Canada. It cuts costs, by reducing the need for Hospitals to “collect” debts.

Patients pay through their taxes, which means that at all times individuals are covered. This simplifies things for patients too. They don’t have to chase around looking for coverage, they are already covered.

I used to travel into the United States a lot on business, and I’ve seen both systems in action. Your health care system is something that Canadians would never put up with.

We have lower infant mortality rates, longer life expectancy, better overall health, and a system that works far more efficiently.

Of course this would put companies like Accretive out of business, however that is a minor issue compared to keeping your citizens healthy.